The Rise and Fall of Pellagra in the American South

Clay, Karen; Schmick, Ethan; Troesken, Werner

doi:10.3386/w23730

Cited by 6 publications

(8 citation statements)

References 38 publications

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“…2 Though pellagra is within the differential diagnosis for chronic diarrhea, it is infrequently the cause and rarely reported in the United Staes. [4][5][6][7] Pellagra is defined as a medical disorder caused by a nutritional deficiency of niacin (vitamin B 3 ). 4,6,8,9 Niacin deficiency may result from inadequate consumption, malabsorption, excess loss, medication side effect, or metabolic derangements.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,10 Pellagra was described as early as 1735 and the first known case in the United States was reported in Georgia in 1902. 6,7,11 There was an exponential increase in cases in southern states. This was attributed to the rise of the cotton industry that displaced local food production and led to decreased niacin consumption.…”

Section: Discussionmentioning

confidence: 99%

“…2 Though pellagra is within the differential diagnosis for chronic diarrhea, it is infrequently the cause and rarely reported in the United States. [4][5][6][7]…”

Section: Introductionmentioning

confidence: 99%

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Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South

Mills

Akintayo

Egbosiuba

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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The triad of diarrhea, dementia, and dermatitis constitutes the clinical diagnosis of pellagra. However, most reported cases of pellagra have occurred without all components of the triad. Pellagra was declared eradicated in the United States after an outbreak in the 1920s, and is now considered to be an exceedingly rare diagnosis in developed countries. In this article, we present a case of a 56-year-old man who presented with a significant history of alcohol use and chronic diarrhea. Pellagra was clinically diagnosed based on the triad of diarrhea, cognitive dysfunction, and dermatitis in this malnourished, alcoholic patient. The patient was treated and clinically improved with resolution of his diarrhea and cognitive dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South

Mills

Akintayo

Egbosiuba

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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“…There is reason to believe that there will be negative relationships between all of the nutrition and income variables and morbidity, although we would expect the relationship to be stronger for some variables than others. Aside from diseases such as rickets and pellagra which are caused by deficiencies in specific micronutrients (Clay et al, 2019), poor nutrition both in quality and quantity can affect disease prevalence through several channels. Nutritional deficiencies can in some cases increase the probability that an individual contracts a noninfectious disease.…”

Section: Calorie Intake Crowding and Health Outcomesmentioning

confidence: 99%

Nutrition, Crowding, and Disease Among Low‐income Households in Tokyo in 1930

2020

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This article employs a household survey of low‐income working‐class households conducted in Tokyo in 1930 to investigate nutritional attainment levels and the relationship between calorie intake and morbidity. We find that the daily calorie intake was 2,118 kcal per adult male equivalent, high enough to satisfy the energy requirements for moderate physical activity. Richer households purchased more expensive calories mainly by substituting meat and vegetables for rice. We find negative associations between morbidity and income and crowding, but no significant associations for nutrition, tentatively suggesting that income and crowding were more important for morbidity in 1930 Tokyo than nutrition.

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“…The United States began voluntary bread enrichment with niacin using high-vitamin yeast in 1938 when the total number of deaths from pellagra in 13 Southern states was about 3000, which represents 90% of total deaths from pellagra in that year (Park, Sempos, Barton, Vanderveen, & Yetley, 2000). No other nutritional deficiency caused more deaths than niacin in U.S. history (Clay, Schmick, & Troesken, 2017). Today, niacin is enriched in refined grain at 24 mg per pound as mandated by the FDA (FDA, 2018).…”

Section: Fortificationmentioning

confidence: 99%

Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity

Titcomb

Tanumihardjo

2019

Comp Rev Food Sci Food Safe

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The prevalence of undernutrition due to insufficient energy intake has been reduced by nearly 50% since 1990. This reduction is largely attributed to improved yields of staple crops, such as wheat, rice, and maize; however, these improvements did little for micronutrient deficiencies that affect an estimated two billion people worldwide. Starchy staple crops are energy dense but are often lacking in one or more B vitamins, making resource‐constrained people who consume monotonous diets comprised predominantly of these staples at risk for developing deficiency. B vitamin deficiencies occur due to a poor overall nondiversified diet and rarely occur alone. Many B vitamins are essential cofactors involved in the metabolism of other nutrients, including other B vitamins, whereby the deficiency of one B vitamin affects the metabolism and status measurements of another. Food fortification efforts have nearly eradicated diseases of extreme B vitamin deficiency, such as beriberi from thiamin deficiency and pellagra from niacin deficiency. However, subclinical deficiency, sometimes referred to as hidden hunger, is still common especially in low‐income countries. Most dietary B vitamins, due to their water‐soluble nature, are not a concern for excessive intakes, but synthetic forms used for fortification and supplements sometimes can have adverse effects when consumed in high amounts. Biofortified crops offer a long‐term sustainable method to increase the amount of dietary B vitamins for people who rely on staple crops for most of their caloric intake. Efforts have been made to improve B vitamin content of crops, especially for thiamin, vitamin B6, and folate, but none have undergone human feeding trials; therefore, more research is needed to provide sustainable and scalable solutions in many parts of the world.

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The Rise and Fall of Pellagra in the American South

Cited by 6 publications

References 38 publications

Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South

Chronic Diarrhea in a Drinker: A Breakthrough Case of Pellagra in the US South

Nutrition, Crowding, and Disease Among Low‐income Households in Tokyo in 1930

Global Concerns with B Vitamin Statuses: Biofortification, Fortification, Hidden Hunger, Interactions, and Toxicity

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